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Definitions

• the invention relates to non-CpG single-stranded oligonucleotides (ssONs) for use in the treatment or prophylaxis of disorders of the skin and/or subcutaneous tissue, including pruritus.
• ssONs non-CpG single-stranded oligonucleotides
• the said ssONs have a length of at least 25 nucleotides and are stabilized by phosphorothioate internucleotide linkages and/or 2'-0-Methyl modifications.
• Skin is the largest organ of the human body. It serves as a barrier to protect against infection, toxins, microbes, and radiation. Disorders of skin not only compromise these functions, but also cause significantly psychological, social, and occupational problems. A significant portion of the world's population is afflicted with skin problems.
• ICD- 10 International Statistical Classification of Diseases and Related Health Problems - 10 th Revision
• Chapter XII includes e.g. atopic dermatitis, psoriasis, rosacea, acne, pityriasis rosea, urticaria, erythema, and pruritus.
• These disorders account for a large portion of annual healthcare costs, in addition to non- financial costs, such as intractable itching, sleep deprivation, psychiatric co-morbidities time spent in treatment, inconvenience, and associated social stigma.
• AD Alzheimer's disease
• Dendritic cells are potent antigen presenting cells with capacity to prime naive T cells after uptake of antigens but are also involved in keeping tolerance [3].
• the functional outcome of DC action is dictated by differential expression of co- stimulatory receptors and inhibitory receptors as well as patterns of cytokine/chemokme secretion.
• the healthy human skin harbors at least three DC populations: Langerhans cells (LCs) in the epidermis; and interstitial CDla + and CD14 + DCs in the dermis [4, 5].
• Oligonucleotides are short DNA or RNA molecules, oligomers, that have a wide range of applications.
• CpG oligonucleotides (or CpG-ssON) are short single- stranded synthetic DNA or RNA molecules that contain a cytosine triphosphate nucleotide ("C") followed by a guanine triphosphate nucleotide (“G”). It is known in the art that CpG- containing nucleic acids stimulate the immune system and can be used to treat infectious diseases, allergy, asthma and other disorders.
• TLR9 Toll- like receptor 9
• the stimulatory effect of the ligand is lost when the CpG repeats are removed. Consequently, the TLR-mediated immunostimulatory effect has not been shown in single-stranded oligonucleotides lacking CpG motifs ("non-CpG ssON").
• IL-10 has been shown that stimulation of the immune system with CpG-containing immunostimulatory motifs leads to induction of pro-inflammatory responses accompanied with induction of IL-10 (see examples in US 7,807,803 B2).
• the antiinflammatory cytokine IL- 10 is well known for its contribution in restoration of homeostasis after cellular injury. Numerous studies in mice have shown that IL- 10 is important to limit autoimmune pathologies.
• IL-10 has been attributed many functions including repression of the major pro -inflammatory cytokines IL-1, IL-6, IL- 12 and TNF-a as well as chemokines of both the CC and CXC type [6].
• the soluble ILT-6, with anti- inflammatory effects was shown to be up-regulated by IL-10 [7]. Even though the anti- inflammatory effects of IL- 10 have been known for a long time and many conditions could be improved by inducing IL- 10, there have been difficulties with the attempts to develop therapeutics based on the administration of IL- 10. Clinical trials in humans using recombinant IL- 10 have shown only marginal success [6]. It has been disclosed (Duffy et al., US2008/0299138 and WO2008/147956; Ranjith- Kumar, C.T. et al. 2008.
• TLR3 Toll- like receptor 3
• ssONs single- stranded DNA oligonucleotides
• TLR3 is a key receptor for recognition of double-stranded RNA and initiation of immune responses against viral infections.
• hyperactive responses can have adverse effects, such as virus- induced asthma.
• Poly(I:C) polyinosine-polycytidylic acid
• Poly(I:C) is a synthetic agonist to for example TLR3 and is often used as an adjuvant in vaccines [see e.g. ref. 28]. It is also well known that injection of Poly(I:C) leads to an inflammatory response, for example if administered to the skin [10]. It was shown [8] that TLR3- mediated events were inhibited in cultures with CpG ssON.
• Poly(I:C) activation of non- hematopoietic cells was also inhibited by CpG ssON.
• the uptake of Poly(I:C) into cells was reduced in the presence of CpG ssON, preventing TLR3 engagement from occurring.
• the levels of proinflammatory cytokines in nasal secretions were reduced when ssONs were administered via the intranasal route.
• Some of these treatments are effective in pruritic conditions of a particular etiology, while others may show general but nonspecific benefit. It is known that many corticosteroids can relieve itch and may be effective in treating some skin disorders. However, prolonged use of such corticosteroids is associated with both cutaneous and systemic toxic side effects and their widespread use is limited without medical supervision. Selenium sulfide, sulfur and salicylic acid or tar shampoo have also been employed to treat these skin conditions. In any event, remission of the pathology or pruritus is often slow and frequently incomplete.
• Nonspecific topical preparations can act as moisturizing lotions or creams or as oil- based ointments that are occlusive and serve to soften diy skin as well as provide a protective layer. While such preparations may have valuable moisturizing and skin softening properties, they also possess undesirable effects in that they generally impart to the skin an uncomfortable feeling of warmth in addition to a sticky, oily, greasy or waxy feel. More importantly, these materials alone have little effect, if any, on reducing itching.
• Figure 3 The ssON treatment dampens expression of several chemokines (A, B) induced by dsRNA in non- human primates and up-regulates inhibitory receptors (C) and antibacterial molecules (D).
• A, B chemokines
• C inhibitory receptors
• D antibacterial molecules
• Relative mRNA expression values obtained from the microarray analyses of individual macaque skin biopsies collected twenty- four hours post-stimulation are shown with means ⁇ SEM. Significant differences were assessed by non-parametric Kruskal-Wallis test and Dunn's post-test (*P ⁇ 0.05, **P ⁇ 0.01 and ***P ⁇ 0.001). Different treatment groups were compared using nonparametric Mann- Whitney unpaired test, as indicated (dashed arrows).
• FIG. 4 Relative mRNA expression values obtained from the microarray analyses of macaque skin biopsies for RAX, LRG1 and LCN2 (A) as well as IL-6, IFN- ⁇ IL- 12p40 (B) are shown with means ⁇ SEM. Biopsies were collected twenty-four hours after intradermal injections of PBS, Poly(I:C), Poly(I:C)/ssON or ssON. Significant differences were assessed by nonparametric Kruskal-Wallis test and Dunn's post- test (*P ⁇ 0.05, **P ⁇ 0.01 and ***P ⁇ 0.001). Different treatment groups were compared using nonparametric Mann- Whitney unpaired test, as indicated (dashed arrows).
• FIG. 5 The ssON treatment induces IL-10 and dampens IL-6 production in vivo. Concentrations of indicated cytokine proteins present in supernatants of enzymatically digested dermis were measured by Bio-PlexTM technology. Data are shown with means ⁇ SEM from individual animals. The lower right panel shows a dose escalation experiment with two animals treated with ssON ranging from 85 to 680 ⁇ g per injection. Significant differences were assessed by nonparametric Kruskal-Wallis test and Dunn's post-test (*P ⁇ 0.05, **P ⁇ 0.01 and ***P ⁇ 0.001). Different treatment groups were compared using nonparametric Mann- Whitney unpaired test, as indicated (dashed arrows).
• Figure 6 Poly(I:C) induced maturation of human monocyte- derived DC.
• Mature DC markers (CD86, CD83 and CD80) were measured using flow cytometry. Experiments were performed using two donors in duplicate.
• Figure 7 Inhibitory effects on Poly(I:C) responses of human monocyte- derived DC by PS-ssONs rich in nucleobases A, T, C and G, respectively.
• Figure 8 Inhibitory effects on Poly(I:C) responses of human monocyte- derived DC by ssONs which were modified with 2'-0-methyl groups.
• the ssONs had either a phosphorothioate (PS) or a phosphodiester (PO) backbone.
• Figure 9 Effects of increasing amounts of complementary PO DNA (allowing formation of dsDNA) on DC maturation. FACS data comes from 3 separate donors in duplicate. Error bars are given in SEM.
• Figure 10 Inhibitory effects on Poly(I:C) responses of human monocyte-derived DC by ssONs of the same length and (PS) backbone but different sequences.
• Figure 11 Inhibitory effects on Poly(I:C) responses of human monocyte-derived DC by ssONs using a randomly mutated 35 ssON with PS backbone.
• Figure 12 Inhibitory effects on Poly(I:C) responses of human monocyte-derived DC by ssONs is length dependent. CD86 and IL-6 secretion was measured using ssONs with varying length. DESCRIPTION OF THE INVENTION
• transcriptional profiling of skin biopsies revealed ssON-dependent dampening of dsRNA- induced pro -inflammatory responses in macaques.
• the ssON-modulated cytokine pattern was confirmed by protein analyses directly ex vivo from skin biopsies and, surprisingly, revealed induction of IL- 10 and inhibition of IL-6 secretion.
• Transcriptional profiling further revealed unexpected increase in expression of antibacterial peptides after treatment with ssON.
• CpG ssONs are capable of inducing pro -inflammatory responses accompanied with induction of IL-10. It has also been disclosed by Skold et al. [8] that a non-CpG ssON (SEQ ID NO: 2) could inhibit Poly(I:C)-induced production of pro-inflammatory cytokines. However, according to the invention, it was unexpected that non-CpG ssONs are capable inducing IL-10, as well as antibacterial peptides, without concomitant pro-inflammatory responses.
• ssON non-CpG
• ssON non-CpG
• this invention provides a single-stranded oligonucleotide (ssON) for use in the treatment or prophylaxis of a disorder of the skin and/or subcutaneous tissue, including pruritus;
• ssON single-stranded oligonucleotide
• the length of the said ssON is at least 25 nucleotides
• the said ssON comprises at least four (preferably at least five or six) phosphorothioate internucleotide linkages and at least four (preferably at least five or six) 2'-0-mefhyl modifications;
• the said ssON does not contain any CpG motifs.
• disorder of the skin and/or subcutaneous tissue comprises the medical conditions coded in ICD- 10 (International Statistical Classification of Diseases and Related Health Problems, 10 th revision). Such conditions include e.g. infections of the skin and subcutaneous tissue (e.g. cellulitis); dermatitis and eczema (e.g. atopic dermatitis and/or pruritus); bullous disorders (e.g. pemphigus); papulosquamous disorders (e.g. psoriasis); urticaria and erythema; disorders of skin appendages (e.g. rosacea); or other disorders of the skin and subcutaneous tissue (e.g. lupus
• the term "disorder of the skin and/or subcutaneous tissue” comprises the medical conditions coded in ICD- 10, Chapter XII, L20-L30 "Dermatitis and eczema", such as in particular L20 "Atopic dermatitis” and/or L29 “Pruritus”.
• the ssON is useful when an infection is associated with the said disorder of the skin and/or subcutaneous tissue.
• the infection may be caused by a disrupted skin barrier, the initial treatment, or by changes in the immune system.
• the length of the ssON is at least 25 nucleotides. More preferably, the length is between 25 and 150; between 25 and 70, between 25 and 50, or between 25 and 35 nucleotides.
• phosphorothioate internucleotide linkages and "PS linkages” refer to internucleotide linkages in which one of the non-bridging oxygens in the DNA phosphate (PO) backbone is replaced by sulfur [16].
• PO DNA phosphate
• PS phosphorothioate internucleotide linkages
• the invention includes the use of ssONs wherein some internucleotide linkages (such as one, two, three or more internucleotide linkages) are PO linkages without sulfur, while the remaining linkages are PS linkages.
• the ssON comprises phosphate groups in the 5'-terminal and/or 3-terminal, such phosphate groups maybe modified (PS) or unmodified (PO) groups.
• 2'-0-Methyl modifications refers to nucleotide modifications wherein a methyl group is added to the 2'-hydroxyl group of the ribose moiety of a nucleoside.
• the ssON to be used according to the invention may comprise additional chemical modifications.
• Chemically modified oligonucleotides are known in the art and disclosed in e.g. Jarver, P. et al. 2014. Nucleic acid therapeutics 24:37-47; and Deleavey, G.F. & Damha, M.J. 2012. Chemistry & Biology 19:937-954.
• Possible chemical modifications include e.g. LNA (Locked Nucleic Acid), wherein the ribose moiety is modified with an extra bridge connecting the 2' oxygen and 4' carbon.
• the ssON could comprise a mix of ribose and deoxyribose as the five-carbon sugar.
• nucleobases in the ssON could be modified.
• Oligonucleotide base modifications include methylation of cytosine to form 5-methylcytosine, and methylation of adenosine to form N6-methyladenosine.
• CpG motifs will be understood to refer to immunostimulatory CpG oligonucleotides, i.e. short single-stranded synthetic nucleic acid molecules that contain a cytosine triphosphate deoxynucleotide ("C") followed by a guanine triphosphate deoxynucleotide ("G").
• C cytosine triphosphate deoxynucleotide
• G guanine triphosphate deoxynucleotide
• p refers to the phosphodiester or phosphorothioate link between consecutive nucleotides.
• CpG motifs are considered pathogen-associated molecular patterns (PAMPs) due to their abundance in microbial genomes but their rarity in vertebrate genomes.
• PAMPs pathogen-associated molecular patterns
• the CpG PAMP is recognized by the pattern recognition receptor (PRR) Toll-Like Receptor 9 (TLR9), which is constitutively expressed primarily in B cells and plasmacytoid dendritic cells (pDCs) in humans and other higher primates. Consequently, the invention does not include the use of ssONs comprising CpG motifs capable of stimulating a TLR9 response.
• the ssON to be used according to the invention has a "sequence independent" mode of action, does not have antisense activity and is not complementary to a gene. More specifically, not more than 16 consecutive nucleotides in the said ssON are complementary with any human mRNA sequence.
• the ssON is essentially "non-complementary" with any human mRNA sequence.
• the term “non- complementary” will be understood to refer to nucleic acid sequences that are not capable of precise pairing (of purine or pyrimidine bases between the two strands of nucleic acids sequences) under moderate or stringent hybridization conditions (i.e. 5- 10°C below T m ).
• the ssON is non-complementary to nucleotide sequences coding for receptor proteins, e.g. Toll-like receptors, such as TLR3 or TLR9, or any other protein which recognize DAMPs (Damage-associated molecular pattern) or PAMPs (Pathogen-associated molecular pattern molecules).
• the ssONs to be used according to the invention are not "antisense" molecules that are complementary to a messenger RNA (mRNA) strand transcribed within a cell.
• oligonucleotide sequences which are "non-complementary" as defined according to the present invention.
• the skilled person could use well-known tools such as the BLAST algorithm as implemented online by the US National Center for Biotechnology Information. See e.g. Madden, T. 2013. The BLAST Sequence Analysis Tool. The NCBI Handbook [Internet], 2 nd edition. ⁇ www.ncbi.nlm.nih.gov/bookiNBK153387)
• the said ssON is not self-complementary.
• the term "not self- complementary” will be understood to mean that the ssON does not have any self- complementary sequences that would allow two ssONs to dimerize, or that would allow parts of the oligonucleotide to fold and pair with itself to form stem loops.
• stem loop also referred to as "hair-pin” loop
• stem loop can occur in single- stranded DNA or RNA. It occurs when two regions of the same strand, usually complementary when read in opposite directions, base-pair to form a double helix that ends in an unpaired loop.
• ssON as defined above does not comprise more than 3 consecutive nucleotides that could form base pairs with another sequence of 3 consecutive nucleotides at the same ssON molecule.
• the said ssON is a single-stranded oligodeoxynucleotide (ssODN).
• ssODN single-stranded oligodeoxynucleotide
• the invention also provides the use of ssONs that are stabilized single-stranded RNA (ribonucleic acid) molecules.
• RNA ribonucleic acid
• the monosaccharides in the ssON are 2'-deoxyribose.
• the term "ssODN” also includes oligonucleotides comprising one or more modified monosaccharides such as 2'-0-methylribose.
• the ssON comprises the sequence shown as SEQ ID NO: 2, 12, 13, 14, 15, 16, or 19 in the Sequence Listing. More preferably, the ssON has (consists of) the sequence shown as SEQ ID NO: 2, 12, 13, 14, 15, 16, or 19.
• At least 30% of the nucleobases in the ssON are chosen from A (Adenine) and T (Thymine) and U (Uracil).
• at least 35%, 40%, 45%, 50%, 55%, or 60% of the nucleobases in the ssON are chosen from A, T and U.
• the ssON is an oligodeoxynucleotide (ssODN), containing deoxyribose as its pentose component
• the nucleobases are normally chosen from A and T.
• the ssON is a ribonucleotide containing ribose
• the nucleobases are normally chosen from A and U.
• the ssONs according to the invention could include synthetic variants which may differ from naturally occurring oligonucleotides.
• the ssON could comprise a deoxyuridine moiety (i.e. uracil bound to deoxyribose).
• the ssON could also comprise nucleobase analogues, which are well known in the art and include e.g. xanthine, hypoxanthine, 7-methylguanine, 5-methylcytosine, and 5-hydroxymethyl- cytosine.
• the invention provides ssONs as disclosed above for use in the treatment or prophylaxis of medical conditions in mammals, in particular humans, wherein the route of administration is selected from parenteral, intramuscular, subcutaneous, epidermal, intradermal intraperitoneal, intravenous, mucosal delivery, oral, sublingual, dermal, transdermal, topical, inhalation, intranasal, aerosol, intraocular, intratracheal, intrarectal, vaginal, gene gun, dermal patch, eye drop or mouthwash.
• the said ssON can be locally administered to a tissue in an amount of from about 70 ⁇ g to about 5 mg/dose, preferably from about 70 ⁇ g to about 700 ⁇ g/dose.
• the range 70-700 ⁇ g corresponds to about 6-60 nmol ssON and is preferably applied per cm 2 of skin or mucosa.
• the said ssON can be systemically administered in an amount from 10 ⁇ g/kg to 10 mg/kg body weight; preferably from about 10 ⁇ g/kg to about 1 mg/kg; more preferably from about 10 ⁇ g/kg to about 100 ⁇ g/kg.
• the ssON to be used according to the invention can be administered in combination with other agents, e.g. anti-inflammatory and/or antipruritic agents such as calcineurin inhibitors, corticosteroids, anti-IL31, PDE-4 inhibitor, IL-4R antibody, anti-IL13, anti-IL22, anti-IL12/23, SB011 (cleaves GATA-3 mRNA) removal/inhibition of IgE, DP2 antagonist, neurokinin- 1 receptor antagonist, topical non-steroidal anti- inflammatory reagents such as LE032731 and GSK2894512, Clonidine, Naltrexone, 5-HT2B receptor antagonist, and/or anti-histamine treatments.
• anti-inflammatory and/or antipruritic agents such as calcineurin inhibitors, corticosteroids, anti-IL31, PDE-4 inhibitor, IL-4R antibody, anti-IL13, anti-IL22, anti-IL12/23, SB011 (cleaves GATA-3 mRNA) removal/in
• the invention provides a method for the treatment or prophylaxis of a disorder of the skin and/or subcutaneous tissue and pruritus; said method comprising administering to a mammal, such as a human, in need of such treatment or prophylaxis an effective amount of an ssON as defined above.
• the invention provides a pharmaceutical composition comprising an ssON as defined above, together with a pharmaceutically acceptable carrier.
• the pharmaceutical composition is adapted for use in the treatment or prophylaxis of a disorder of the skin and/or subcutaneous tissue, including pruritus.
• the invention provides a single-stranded oligonucleotide (ssON), wherein the said ssON comprises the nucleotide sequence shown as SEQ ID NO: 15 or 16; provided that the ssON does not have the sequence shown as SEQ ID NO: 2.
• the said ssON comprising the nucleotide sequence shown as SEQ ID NO: 15 or 16 has at least one, more preferably two, three, four or five, of the following features:
• the length of the said ssON is between 25 and 70 nucleotides, more preferably between 25 and 35 nucleotides;
• the internucleotide linkages in the said ssON are phosphorothioate internucleotide linkages; or (ii) the said ssON comprises at least four (preferably at least five or six) phosphorothioate internucleotide linkages and at least four (preferably at least five or six) 2'-0-methyl modifications; and
• the said ssON is not self-complementary.
• the said ssON comprises a nucleotide sequence shown as SEQ ID NO: 12, 13, 14, or 19. More preferably, the said ssON has a nucleotide sequence shown as SEQ ID NO: 12, 13, 14, 15, 16, or 19.
• Synthetic, endotoxin- free, oligonucleotides were synthesized according to methods known in the art, as disclosed in e.g. Artificial DNA: Methods and Applications (Khudyakov, Y.E. & Howard A. Fields, H.A., Eds.) CRC Press, 2002 (ISBN)
• the synthesized oligonucleotides do not carry any phosphate groups on neither the 5 '-terminus, nor the 3 '-terminus.
• Monocytes were negatively selected from buffy coats using the RosetteSep Monocyte Enrichment KitTM (1 mL/10 mL buffy coat; StemCell Technologies) and differentiated into DC, as described previously [8] at a density of 5x10 s cells/mL in RPM 1640 completed with 10% FCS, 1 mM sodium pyruvate, 10 mM HEPES, 2 mM L-glutamine, and 1% streptomycin and penicillin (all from Invitrogen Life Technologies), with GM- CSF (250 ng/mL; PeproTech) and IL-4 (6.5 ng/mL; R&D Systems) for 6 or 7 days.
• RosetteSep Monocyte Enrichment KitTM (1 mL/10 mL buffy coat; StemCell Technologies
• the cells were phenotyped with Abs against CD 14, CD la (both from DakoCytomation), CD3, and CD 19 (both from BD Biosciences). Maturation was assessed 48h post- stimulation using Abs targeting CD 1 a (DakoCytomation), CD80, and CD86 (both from BD Biosciences). Sample data were acquired on a FACSCaliburTM or FortessaTM (BD Biosciences); the analysis was performed with FlowJoTM software (TreeStar).
• RNA Whole skin RNA were extracted from macaque skin biopsies, stored at least 24h at 4°C in RNA Later, using Tissue Ruptor ® followed by RNeasy Plus Universal KitTM
• RNA was extracted using TempusTM Spin RNA Isolation kit (Applied Biosystems) according to the manufacturer ' s protocol. Total RNA was quality checked on Agilent 2100 BioanalyzerTM. RNA quantity was measured using NanoDrop ND- 1000TM Spectrophotometer. Cyanine-3 (Cy3) labeled cRNA was prepared from 200 ng Total RNA using the Quick Amp Labeling KitTM (Agilent) according to the manufacturer's instructions, followed by RNeasy column purificationTM (QIAGEN, Valencia, CA). Dye incorporation and cRNA yield were checked with the NanoDrop ND- 1000TM Spectrophotometer.
• Ingenuity Pathway AnalysisTM software (Ingenuity Systems) was used to identify canonical signaling pathways regulated by Poly(I:C) alone or in combination with ssON.
• For calculation of significance of enrichment (Fisher's exact test performed within the software) reference dataset used was Agilent Rhesus Macaque Gene Expression Microarrays v2.
• EXAMPLE 1 SsON inhibits DC maturation and pro-inflammatory cytokine responses in vitro It was shown that immature DC up-regulated the co-stimulatory molecules CD80 and CD86, as well as the maturation marker CD83, after stimulation with the dsRNA mimic Poly(I:C) (Fig. 1A). The dsRNA-induced maturation was significantly inhibited in the presence of the 35-mer ssON designated “nonCpG 35 PS" (Table II) (pO.0001) (Fig. 1A). The ssON "nonCpG 35 PS” contained phosphorothioate (PS) modifications, which have been used to increase half-life of ssONs [18].
• PS phosphorothioate
• EXAMPLE 2 Intradermal injection of ssON modulates local cellular infiltration in non-human primates
• Poly(LC) LC
• Multicolor flow cytometry was used to phenotype cells isolated from epidermal and dermal layers. In the epidermis, three main leukocyte populations were identified. Langerhans Cells (LC) expressed CD45 and high levels of HLA-DR as well as CD la. CD45 + cells expressing HLA-DR but not CD la were denoted antigen-presenting cells (APC).
• APC antigen-presenting cells
• PMN Polymorphonuclear cells
• Macrophages as defined by expression of CD45 + CD 1 1 c low HLA-DR + CD 14 + , were almost absent in control biopsies (PBS injection), and accumulated when Poly(I:C) was administered alone, while addition of ssON resulted in lower influx.
• CDla + and CD14 + dermal DC both subsets defined by additional expression of CD45 + CDl lc + HLA-DR + , were recovered from control biopsies and seemed to disappear after intradermal injections with either Poly(I:C) or Poly(I:C)/ssON (Fig. 2C). Importantly, the quantity of cells collected was dependent on the treatment because very few if any CD45 + CD66 + PMNs were found at the PBS control site.
• PMNs are considered to be a typical inflammatory cell population.
• the phenotype of the infiltrating PMNs after ssON administration would suggest recruitment of "inflammatory cells" to the site of injection. It was consequently surprising that ssONs, without any CpG motifs, are null to the immune system or only possess "anti-inflammatory" signatures.
• EXAMPLE 3 Transcriptional profiling To assess the global innate response to Poly(LC) in the presence or absence of ssON, whole transcriptional profiling was performed on whole blood samples and skin biopsies obtained from macaques as described under "Experimental Methods". The majority of top 50 responsive genes (FC range 3.5-22; p ⁇ 0.05) detected in blood twenty-four hours after intradermal injection with Poly(I:C) were either IFN-regulated genes or associated with NF- ⁇ activation confirming response patterns previously reported in blood from human subjects [17]. No significant differential expression was detected in blood in the group that received Poly(I:C) and ssON ("nonCpG 35 PS"; Table II) relative to baseline (15% FDR).
• the expression profiles of the skin biopsies displayed an even more robust and high induction of innate immune response genes also reflecting influx of cells.
• Many of the top 50 induced genes in the skin were, similarly, IFN-regulated genes with a FC range of 29-1870 at 5% FDR after Poly(I:C) injection and a FC range of 28-929 at 5% FDR after Poly(I:C)/ssON co-administration.
• FC range of 29-1870 at 5% FDR after Poly(I:C) injection
• FC range of 28-929 at 5% FDR after Poly(I:C)/ssON co-administration.
• the top down-regulated genes include chemokines and genes implicated in inflammatory conditions.
• canonical pathway analysis was performed using the Ingenuity Pathway AnalysisTM software.
• Several pathways for innate immunity such as "Communication between innate and adaptive immune cells”, “Crosstalk between dendritic cells and natural killer cells” and “TREM1 Signaling” were engaged and includes induction of pro-inflammatory cytokines and interferon signaling, consistent with the molecular signatures discovered in the proteomic profiling of dendritic cells.
• Poly(I:C) stimulated DC maturation in concordance with the flow cytometry data obtained.
• chemokines were modulated by ssON, showing reduced expression of Ccl5, Cxcl9, CxclIO, Cxclll and a further increase of Cclll expression [20], consistent with increased influx of PMNs, in animals receiving combined Poly(I:C)/ssON treatment. Furthermore, injection of dsRNA resulted in significant increase oilcaml expression, while the simultaneous treatment with Poly(I:C)/ssON, led to lower expression of Icaml (Fig. 3B).
• ILT immunoglobulin- like transcript receptors
• immunomodulatory signature The addition of ssON resulted in selective inhibition of pro-inflammatory responses such as IL-6, IFN-gamma, CCL5, CXCL9, CXCL10 (also known as IP- 10) and CXCL11.
• pro-inflammatory responses such as IL-6, IFN-gamma, CCL5, CXCL9, CXCL10 (also known as IP- 10) and CXCL11.
• EXAMPLE 4 SsON reduces Poly(I:C)-induced pro-inflammatory cytokines and induces IL-10 secretion
• Rax the cellular activator of interferon-induced, double-stranded RNA-activated protein kinase; PKR
• PKR cellular activator of interferon-induced, double-stranded RNA-activated protein kinase
• genes implicated in inflammatory conditions such as Lrgl and Lcn2 were significantly reduced after Poly(I:C)/ssON treatment, further adding support for ssON- mediated a dampening of inflammation (Fig. 4A).
• Poly(I:C) induced pro-inflammatory cytokines such as IL-6, IFN- ⁇ and IL12p40 (Fig. 4B).
• ssON dampened the pro-inflammatory response, including IFN- ⁇ which is known to regulate many chemokines [27].
• transcriptional profiling of skin biopsies revealed ssON-dependent selective dampening of dsRNA-induced pro-inflammatory responses in macaques.
• the ssON-modulated cytokine pattern was confirmed by protein analyses directly ex vivo from skin biopsies and revealed induction of IL-10 and inhibition of IL- 6 secretion.
• These data demonstrate that treatment with the ssON can dampen dsRNA- induced inflammation in macaques.
• the data unexpectedly show induction of IL-10 and anti-bacterial peptides after administration of ssON even without any induction o f inflammation.
• EXAMPLE 5 Introduction of non-natural linkages and modified nucleosides in ssONs As shown in Example 1, the 35-mer ssON denoted “nonCpG 35 PS" (SEQ ID NO: 2; Table II) with fully substituted phosphorothioate (PS) backbone, could block Poly(LC) induced maturation of DC in a concentration dependent manner. DC maturation was monitored by measuring expression of the co-stimulatory molecules CD86 and CD80 (Fig. IB).
• NonCpG 35 PS Fully PS-substituted ssON
• PO phosphate
• the inhibitory effects on Poly(I:C) responses by ssONs which are fully modified with 2'-0-methyl (2'OMe) groups were investigated.
• 2'-0-methylation is a common nucleoside modification of RNA, where a methyl group is added to the 2' hydroxyl group of the ribose moiety of a nucleoside.
• the ssONs had either a phosphorothioate backbone ("nonCpG 2'OMe PS"; Table II) or a phosphodiester backbone ("nonCpG 2'OMe PO"; Table II). It was shown (Fig. 8) that 2'OMe could inhibit DC maturation in the same fashion as DNA if the oligonucleotide backbone was stabilized by PS linkage. A native PO backbone was less stable and the inhibitory effect was not retained.
• the ssONs shown in Table V were prepared as described in e.g. Current Protocols in Nucleic Acid Chemistry (Wiley Online Library).
• SsON 35 PS SEQ ID NO: 2
• ssON GtA PS SEQ ID NO: 3
• ssON Compl PS SEQ ID NO: 5
• SsON GtA is based on the parent sequence ssON 35 (SEQ ID NO: 2), but all the guanosine (G) bases have been substituted to adenosine (A), while ssON Compl is the complementary sequence to ssON 35.
• the three ssONs are all 35 bases long, and have a fully PS substituted backbone. Furthermore, a random substitution of G to A at position 29 (SEQ ID NO: 19) display a similar effective inhibition of CD80 and CD86 expression in DCs as parent ssON 35 (SEQ ID NO: 2) (Fig. 1 1). Although sequence independent, we unexpectedly revealed a defined length-dependent requirement for inhibition of CD86 expression on DCs and release of IL-6 (Fig. 12).
• the shorter 30 and 25 ssONs (SEQ ID NO: 13 and 15) display similar inhibitory effect as the 35 ssON (SEQ ID NO: 2), while there was a marked reduced efficacy using 20 ssON (SEQ ID NO: 17), or 15 ssON (SEQ ID NO: 20).
• Pruritic or itch responses are triggered by activation of sensory receptors expressed on primary afferents by the release of itch-inducing agents.
• the capacity of ssONs to influence itch in murine models recording number of scratching episodes/h is evaluated using a digital camera.
• both the intensity and the duration of itch are measured by an observer blind to the treatment, using AniTrackerTM version 1.0, a software tool for analysis of animal behavior in life science.
• ssONs on histaminergic/PLCP3 -induced itch is evaluated after intradermal inoculation with (a) histamine; (b) Compound 48/80, a compound that promotes histamine release; and/or (c) oc-5HT (also known as a-methylserotonin); which are known to be pruritogenic.
• Table V Explanation of ssONs used in Example 6. All oligonucleotides are fully phosphorothioated and consists of deoxynucleotides.
• Soluble LILRA3 a potential natural antiinflammatory protein, is increased in patients with rheumatoid arthritis and is tightly regulated by interleukin 10, tumor necrosis factor-alpha, and interferon-gamma. The Journal of rheumatology 37: 1596-1606.
• Keratinocytes as targets for interleukin-10-related cytokines a putative role in the pathogenesis of psoriasis.
• Plasmacytoid dendritic cell-specific receptor ILT7-Fc epsilonRI gamma inhibits Toll- like receptor-induced interferon production.
• Siglec-5 and Siglec-14 are polymorphic paired receptors that modulate neutrophil and amnion signaling responses to group B Streptococcus. The Journal of experimental medicine 211 :1231-1242.
• Rhesus macaque theta-defensin RTD-1 inhibits proinflammatory cytokine secretion and gene expression by inhibiting the activation of NF-kappaB and

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